Feeding tolerance in premature infants fed fortified human milk

Background: To evaluate feeding tolerance in premature infants immediately after the addition of human milk fortifier (HMF) to their expressed human m ilk diet. Methods: Data on milk intake, feeding tolerance, and related assessments an d growth milestones from a prospective study of feeding strategies in prema ture infants were analyzed. The database was searched for the first day HMF was added to the feeding of infants receiving human milk exclusively. The following assessments were tabulated for the 5 days before and the 5 days a fter the addition of HMF: milk intake, the number of episodes of abdominal distension, gastric residual volume (GRV) more than 2 ml/kg and more than 5 0% of the volume fed in the prior 3 hours, bile-stained gastric residual, e mesis or regurgitation. blood in the stool, the number of abdominal radiogr aphs, the number of episodes of apnea and bradycardia, changes in findings in the clinical examination, and the number of hours feeding was withheld. The time to achieve full tube feeding, complete oral feeding, and hospital discharge were recorded. Results: Seventy-six exclusively human milk-fed premature infants (birth we ight, 1065 +/- 18 g; gestational age, 27 +/- 0.1 weeks; mean +/- SEM) who r eceived HMF beginning 22 +/- 0.8 days of age were evaluated. There were sig nificant increases in milli intake and in the number of episodes of GRV mor e than 2 ml/kg and emesis after the addition of HMF. There were no differen ces in the number of hours feeding was withheld or any other assessment aft er the addition of HMF. Infants with increases in GRV more than 2 ml/kg and /or emesis after the addition of HMF were not more likely to be delayed in the time to achieve full tube feeding, complete oral feeding, or hospital d ischarge than infants who did not experience these events. Conclusion: These data suggest that, when all feeding and related assessmen ts and the time to achieve important growth milestones are considered, the addition of HMF does not adversely affect the outcome of the premature infa nt.